guiding effective drug prevention - ascert · • those wishing to set up a prevention project –...

Guiding effective drug preventionRevised edition

Rationale For the purpose of this paper, a drug is defined as a substance that changes the body in some way. This includes alcohol, tobacco, over-the-counter and prescribed medication, volatile substances and controlled drugs.1

Why a paper on effective prevention?• Tocontributetothedebatewithinthefieldaroundapproachestodrugprevention.• Todefinepreventionanditscomponents,andtopresentkeyprinciples–drawnfrompreventative researchandappliedwithinalocalcontext–thatarecentraltobestpractice. Who is it for?• Thosewhoworkacrosstiersoneandtwowithinthevoluntary,statutoryandcommunitysectors.• Thoseworkingprimarilywithyoungpeople;however,manyoftheprinciplesalsoapplywithinanadult context.

What does it hope to achieve?• Highlightandpromotebestpractice/approachesindrugprevention.• Createacommonlanguagethatwillstrengtheninteragencyandintersectoralcollaboration.• ContributetotheprioritiessetoutintheNew strategic direction for alcohol and drugs 2006-2011 (NSDAD) including:2

➢ promotinggoodpracticeinalcoholanddrug-relatededucationandprevention;➢ targetingthoseatriskandmorevulnerableyoungpeople;➢ addressingunderagedrinking;➢ tacklingalcoholanddrug-relatedantisocialbehaviour;➢ workforcedevelopment.• Contributetothefutureplanningandcommissioningofservices.

ThispaperoriginatesfromoneinitiallyproducedbyEDACTin2005by:PeterDornan,EducationandPersonalDevelopmentOfficer,BELB;MichaelMcKay,SHAHRPProject,LisburnYMCA;andEdSipler,HealthDevelopment Department, South Eastern Trust.3Itwasupdatedandamendedin2009by:KimScott,SouthEasternEducationandLibraryBoard;andMichaelMcKayandEdSipler

Guiding effective drug prevention 1

2 Guiding effective drug prevention

Contents

Foreword 4

Introduction 5

Setting the scene: the current situation 6

What do we mean by prevention? 8

Effectivepreventionprinciples PULLOUTSECTION

Planningandinitiatingapreventionprogramme 13

Conclusion 16

Appendix 1 Four tier model of services 17

Appendix 2 Indicated prevention 18

Appendix3NICEguidance 20

References 22

Bibliography 24


Page

ForewordAround35%of16–24yearoldsinNorthernIrelandreporthavingeverusedanillegaldrug.Whilstencouragingly,overallprevalencehasdeclinedsince2001,therehasbeenasignificantincreaseintheuseofcannabis, particularly in some of the most vulnerable populations of young people. Early intervention and effectivepreventionarekeyinpreventingyoungsubstanceusers,orthosesusceptibletouse,developingproblems later in their life.

Preventionisdifficult.RecenthighprofilereportsbytheAdvisoryCouncilfortheMisuseofDrugsandUKDrugPolicyCommissionarguedthataspreventioninterventionshavenothadsignificantimpactsonlevelsofdruguse,they should be reassessed, particularly in schools and community settings.4,5However,relianceonprevalence rates as indicators of success misses some important opportunities.

Substance use should not be seen in isolation from other issues and behaviours. The Northern Ireland drugs strategyNSDAD,publishedin2006,combinedbothdrugsandalcoholinonestrategicframeworkandresponded well to the challenges of prevention.2 Among its many aims is the “promotion of opportunities for those undertheageof18yearstodevelopappropriateskills,attitudesandbehaviourstoenablethemtoresistsocietalpressurestodrinkalcoholand/oruseillicitdrugs,withparticularemphasisonthoseidentifiedaspotentially vulnerable”.

Byseeinginterventionsintheirwidercontext–beyonddrugusetothewholeofayoungperson’sbiography–drugservicescanprovideanintegratedpackageofsupportthatcanpotentiallyreducearepertoireofriskandproblematicbehaviours.Drugpreventionisnotjustaboutdrugs(discussedinmoredetailinthebodyofthereport).

Whatshouldlocalagenciesdo,then,totacklesubstanceuseandotherchallengesinyoungpeople?Thereisnoeasy answer but there are some things to always bear in mind. Firstly, professionals should always respond to, and predict,theacuteandchronicneedsoftheclient,inwhichsubstanceusemayonlybeasecondaryconcern.Youngpeople themselves should subsequently have a voice in decisions made over the support they receive.

Itisalsowellestablishedthatevidence-basedandevidence-informedinterventionsaremuchmorelikelytoachievethedesiredoutcomes.TheNationalInstituteforHealthandClinicalExcellence(NICE),forexample,issuedguidance on prevention of substance misuse in vulnerable young people.6 Whilst this describes approachesthatresearchsuggestsareeffective,manyorganisationswillnothavetheskillsorresourcestoimplement these sometimes technical interventions.

This is where this report is essential. By developing services in accordance with strong, evidence-based principles, agencies can be confident that they have templates for success. Indeed, the Northern Ireland drugs strategy highlighted the prevention principles contained in this document as an example of good practice. The challenge comes in ensuring that these principles are translated into credible interventions that are sensitive to the needs of, andengageandretain,thetargetpopulation.Thisiswheretheuniqueskillsofprofessionalsworkingwithyoungpeople are critical.

Finally, it is important for agencies to document and evaluate their activities. This allows development and sharing of unique approaches that may be of great relevance to other professionals. Good evaluation ensures that thework,andtheoutcomesofthatwork,isrecordedinastandardwaythathasthepotentialtocontributetothewider evidence base.

Dr Harry Sumnall SeniorResearchFellow,NationalCollaboratingCentreforDrugPrevention(NCCDP);ReaderinSubstanceMisuse,CentreforPublicHealth(CPH),LiverpoolJohnMooresUniversity(LJMU)


IntroductionPrevention,theysay,isbetterthancure.Itiscertainlycheaper.Intermsofdrugsandalcoholtherearemanyinitiativesandprojectsthatcanbecategorisedas”prevention”.

Theseprojectsaretypicallyaimedatindividualsorgroupsofpeoplebeforedrugandalcohol-relatedproblemsbecomeareality,andareusuallydeliveredbeforeusebeginsorduringtheexperimenting(recreational/occasional use) stage.

Thisdocumentseekstoexplorethenatureofpreventionworkintheworldofdrugsandalcohol.Furthermore,itseekstoofferpracticaladviceandsupporttothoseengagedinpreventionwork,andtogivedirectiontothoseembarkingonnewpreventioninitiatives.

Itisaguidetowhateffectivepreventionmeans–notanexhaustiveliteraturereview,whichhasbeendoneelsewhere (see Bibliography).

Thedocumentisprimarilyforthoseworkingwithyoungpeople;however,manyoftheprinciplesalsoapplywithinanadultcontext.Youngpeoplearedefinedinthisdocumentasbeing17andunder;however,asstatedintheNSDAD,insomepreventativesettingstheagerangewouldbe25yearsandunder.2

Forthosealreadydeliveringdrugpreventioninitiatives,thedocumentshouldprovideabenchmarkagainstwhichtoreviewyourcurrentprovisionandforplanningfuturedrugpreventionwork.

Asstatedearlier,itisprimarilyaimedatworkersacrosstiersoneandtwo.Thefour-tiermodelofservicesispresentedinAppendix1withadescriptionofthetiers,keytasks,andwhocancarryoutthiswork.

Thedocumentdoesnotseektoequipthosewhoreaditwithalltheskillsnecessarytoworkineveryareaofdrugprevention.Itmaybethatworkersonthegroundofferinggeneralpreventionservicesshouldemploya system of “alert and referral” so that they would refer on to services with more expertise should some problematic drug and alcohol issues arise.

Therefore, it is hoped that this document will be of use to:• thoseworkinginthefieldofpreventionsuchasteachers,communityorvoluntarysectororganisations, youthandcommunityworkers,etc–thedocumentwillgiveyouadeeperunderstandingofthe backgroundtodrug/alcoholpreventionwork,andwillenableyoutocontextualisetheworkinwhichyou areengaged;• thosewishingtosetupapreventionproject–thedocumentwillhelpyouunderstandsome backgroundideasandconceptstodrug/alcoholprevention;• thosesimplywishingtoknowmoreaboutprevention.

The focal point of the document is a centre page pullout highlighting 12 principles of best practice for effective drugpreventionwork.Theremainderofthedocumentprovidesbackgroundinformationandcontextfortheseprinciples.

Itisourhopethatthisdocumentwillgosomewaytomakingpreventioninitiativesmoreeffectiveandengagingthroughout the region.

Guidingeffectivedrugprevention5

Setting the scene: the current situationAccordingtothefindingsofthefirstjointdrugprevalencesurveyofhouseholdsinIrelandandNorthernIreland,oneinfive(20%)ofrespondentsinNorthernIrelandadmittedlifetimeuseofanillegaldrug.7Cannabiswasthemost commonly used illegal drug, and young people reported higher rates of illegal drug use than older people.

Asecondaryanalysisofthe2007/2003Young persons behaviour and attitudes survey found that of the pupils surveyed(aged11–16),lifetimeuseofanydrugsorsolventshaddecreasedfrom23%in2003to18.9%in2007;withlastmonthusealsodecreasingfrom11.5%in2003to7.5%in2007.8,9 For alcohol, between 2003and2007,theproportionofpupilseverhavinganalcoholicdrinkdecreasedfrom59.9%to55.1%.Amongpupilswhohadeverdrunkalcohol,therewasnosignificantchangebetween2003and2007intheproportionswhoreportedeverbeingdrunk(55.2%in2003comparedto54.5%in2007).

Belfast Youth Development Study (BYDS)TheyouthdevelopmentstudyisanongoinglongitudinalresearchprojectonadolescentdevelopmentbytheInstituteofChildCareResearch,Queen’sUniversityBelfast.10Over3,500schoolchildren,across43postprimaryschools,haveparticipatedinthestudysince2000.TheyoungpeoplewereallYear8pupils(FirstForm)in2000,andwereinterviewedannuallyuntil2005(Year12,FifthForm).Thedatacollectionwasrepeatedin2007whentheyoungpeoplewereagedaround18,andagainin2009whentheywereagedaround20.

Theresearchershavecollectedinformationonadolescentlifeincludingsmoking,alcoholanddruguse,theirfriendshipnetworks,relationshipswiththeirparentsandfriends,personality,leisureactivities,behaviourproblems, attitudes to education, and behaviour in school and the neighbourhood in which they live. In addition to the main cohort study, interviews were conducted with the family members (parents and older siblings) of a sub-sample of cohort members.

To date, the research team has identified a number of important issues, including as follows:• Whiledruguseisverylimitedamongyoungpeopleintheirfirstyearofsecondaryschool(age11–12), bythetimetheyareaged15almosthalfhaveusedanillicitdrugandover1in10havemadethe transitiontomoreregulardruguse(onceperweekormore).• Regulardrugusers,byage15,aremorelikelytobeincontactwiththecriminaljusticesystem, experience drug related problems, and problems at school.• Increaseddisposableincomeamongteenagersisassociatedwithincreasedlevelsofdruguse,even after controlling for family socioeconomic conditions. • Earlyonsetcannabisuseislinkedtosustainedcannabisuseacrosstheschoolyears.• Whileboystendtousedrugsfirst,byage15thereislittledifferenceintheprevalenceofdrug useamongboysandgirls.Theoneexceptionissmoking,wherethenumberofgirlsmokersexceeds the number of boys. • Higherlevelsofdrugusewerefoundamongparticularsub-populationsofyoungpeoplesuchasthose excluded from school, those in care, those living in single parent households, and those attending emotional and behavioural units. • Whilemostparentswereawarethattheirchildhaddrunkalcohol(65%),fewwereawarethattheir childhadbeeninvolvedinanydelinquentactivities(between0.5%and6%dependingontheoffence). Around6%believedthattheirchildhadtriedillicitdrugs.• Whileparentstendedtohavenegativeattitudestowardsdruguse,over10%ofthemhadused cannabisand3%amphetamines.


Strategic contextManyofthestrategicdocumentsthathelpguidetheworkinthedevelopmentofyoungpeopleinNorthernIreland present a consistent message.

Allofthecurrentstrategyandpolicydocuments–whetherproducedbytheDHSSPS(Investing for Health, NSDADetc)ortheothergovernmentdepartments(OFMDFM’sOur children and young people: our pledge, DENI’sReview of the Northern Ireland curriculum,etc)havetheultimateaimofworkingtowardschangingandshaping services so that young people can achieve their full potential.11,2,12,13

TheNSDADinconjunctionwiththeactionplansfromthelocaldrugandalcoholcoordinationteamswillbeguidingpreventioneffortsuntil2011.TheNSDADemphasisestheneedtofocusmoreonvulnerableandatriskgroups, the role of assessment and referral, and the importance of evaluation.2

All of these documents view drug and alcohol misuse as detrimental to adults and young people reaching their full potential.


What do we mean by prevention?By definition, to “prevent” something means to stop something from happening. “Drug prevention” traditionally has referred to a range of activities, from regulation to education, with the aim of controlling the supply of drugs and reducing of the demand for them.14

Is prevention effective?Measuringsuccessofanypreventioneffortsbyprevalenceratesaloneismisleading.Prevalenceratesasaperformance indicator reveal nothing about substance abuse behaviour and harm related to substance misuse.

Manyyoungpeopleexperimentwithalcoholanddrugsanddonotdeveloplong-termproblems.Drugprevention cannot innoculate against drug use.

Contemporarydrugpreventionviewssubstanceuseasonepartofayoungperson’sstory–inwhichtheremaybemanymoreproblematicoracuteneeds.Manypreventioninitiativesforyoungpeoplearededicatedtoprovidingwidersupportandreducingtherepertoireofriskandproblematicbehaviours.

Drug and alcohol prevention projects and initiatives therefore aim to:• preventinitialuse;• delayonsetofuse;• promotecessationofuse;• reduceharmsresultingfromuse.

Effective drug prevention may not even explicitly mention substances.

It may be judged successful if it reduces risk factors for use or for problematic use.

Risk and protective factorsIt has been suggested that a promising route to effective prevention for problematic alcohol and other drug problemsisthrougharisk-focusedapproach.15Thisapproachidentifieskeyriskfactorsthatincreasethelikelihoodofyoungpeopledevelopingproblemsacrossarangeofriskybehaviour.

Their research also points to the existence of protective factors, also referred to as assets or strengths, which reducethelikelihoodofthedevelopmentandmaintenanceofproblematicbehaviourincludingsubstancemisuse. The resiliency research also identifies these protective factors as being significant in helping young people thrive in quite difficult circumstances.16

Thisapproachrequiresidentificationofmethodsbywhichriskfactorsareeffectivelyaddressedandprotectivefactorsenhanced,andtheapplicationofthesemethodstobothhighriskandgeneralpopulations.Whyisthisimportant?

Whenriskfactorsarereducedinindividuals,andalsoacrossfamilies,schoolsandcommunities,andprotective factors enhanced, young people are lesslikely to develop more acute problems, such as physical, mental,socialand/orrelationshipproblems.15 Even with well thought-out prevention initiatives, success is not guaranteed.

Riskandprotectivefactorsinteractinacomplexway,notinasimplecause/effectmechanism.Bothriskandprotective factors can have an additive or multiplying effect.17,15


All of these documents view drug and alcohol misuse as detrimental to adults and young people reaching their full potential.

Understandingandidentifyingriskfactorsmayhelpindividualprojects,organisationsandkeycommunityfigurestodevelopthemosteffectiveandappropriateinterventionforsubstancemisuse/abuse/dependence.

As stated several times in this paper, effective prevention may not be specifically addressing drugs, but building protectiveprocessesandreducingriskfactors.Thisisparticularlyimportantforat-riskandvulnerableyoungpeople.

The drug and alcohol continuumVarious developmental stages exist for individuals in terms of their use of drugs and alcohol, ranging from non-usethroughtodependence(addiction).The“drug/alcoholusecontinuum”canbedepictedasfollows:

For a more complete discussion of risk and protective factors resources tools or other information outlined in this paper, visit the Local Resources section of www.edact.org or see Hawkins et al.15

Perhaps the most important thing to note from this diagram is the demarcation between prevention and treatment.

Prevention initiatives can still be effective with regular drug and alcohol misusers. If the person slips into abuse/dependency, treatment services are needed rather than prevention.

Employingthisnotionofadrug/alcoholusecontinuum,weknowfromexperiencethat:

• Noteveryonewillnecessarily progress downwards, therefore dependence is not inevitable.• Manypeoplecanmoveforwarda stageorbackastagebychoice,but for some there is an imperceptible drift.• Effectivepreventionstrategiesneed to clearly and properly determine whatstagetheperson(orpeople)is/ are at and act accordingly. What is effective at one stage may be ineffective at another.Movement from one stage to another may not always be immediately obvious. • Experimentationwithcontrolled drugs, while illegal, does not always leadtoproblemsinaperson’slife.

Prevention Treatment

Drug/alcohol continuum1. Non -use

2. Experimental use

3. Regular use/ misuse

5. Dependence

4. Abuse

Drug/alcohol continuumDrug/alcohol continuum

1. Non-use

2. Experimental use

3. Regular use/

4. Abuse

5. Dependence

misuse


Assessment toolsA role in tier one and two is the identification of problematic substance misuse. Services should have policies andproceduresthatguidetheirworkers’responses.

An initial substance misuse assessment tool for use with those aged 17 was piloted for use in Northern Ireland. TheRegionalInitialAssessmentTool(RIAT)isintendedtobeofusetomainstreamchildren’sservicesandwillbepilotedwithineducation,youthjustice,socialservicesandyouthcommunity/voluntarysettingsacrosstheregion prior to being rolled out.

Itallowsworkerstoundertakeabriefassessmentofayoungperson’ssubstancemisusetohelpdeterminewherethepersonisonthedrug/alcoholcontinuum,andthereforewhatlevelofsupport(ifany)theyoungper-son may benefit from. The tool is accompanied by a guidance document that details what services are available locally for young people spanning drug education, prevention, early intervention and treatment. It also gives instructions as to when and how to refer young people onto services.

FormoreinformationontheRIAT,pleasecontactyourlocalDrugsandAlcoholCoordinationTeam(contactdetailsonthebackcover).

KeymessageWorkers on the ground offering general or drug-specific prevention initiatives, and who find their client’s drug use is becoming progressively worse, should employ a system of “alert and referral”. They should refer-on to services with more expertise.

People should not undertake assessment and offer services or interventions in which they are not experienced and/or trained.

10Guidingeffectivedrugprevention

Levels of preventionIna1994reportonpreventionresearch,theInstituteofMedicine(IOM)proposedanewframeworkforclassifyingpreventionbasedonGordon’sOperational classification of diseases.18,19

TheIOMmodeldividesthecontinuumofcareintothreeparts:• prevention;• treatment;• maintenance.

The prevention category is further subdivided into three classifications:• universal;• selective;• indicated.Viewed simply, these three classifications refer to the target audience of a specific programme.

In practice, the following is understood:

Universal preventionUniversalpreventioninterventionsaretargetedatthegeneralpopulationorsub-sectionsofthegeneralpopulationsuchasindividualcommunitiesorschools,regardlessoftheperceivedriskofinitiatingdruguse.Childrenandyoungpeopleareusuallythefocusofsuchuniversalinterventions,withtheemphasisonthepreventionofprecursorsofdruguseortheinitiationofuse.Universalpreventionactivitiesmayincludeschools-based prevention programmes or mass media campaigns, or they may target whole communities, or parents andfamilies.Examplesofthiskindofinterventioninclude:• acurriculum-baseddrugpreventionprogrammeinschools;• abingedrinkingmediacampaign.

Selective preventionSelective prevention interventions target groups or subsets of the population who may have already started tousedrugs,orareatanincreasedriskofdevelopingsubstanceuseproblemscomparedtothegeneralpopulation, or both.20Childrenexcludedfromschoolandthechildrenofdrugusersareexamplesofgroupswho may be particularly vulnerable to drug use and misuse. Selective prevention interventions are generally longerandmoreintensethanuniversalprogrammesandmaydirectlytargetidentifiedriskfactors.Examplesofthiskindofinterventionwouldinclude:• YouthJusticeAgencyinitiatives;• anearlyinterventiongroupworkinitiatedwithyoungpeopleatrisk.

Indicated preventionIndicated prevention interventions target individuals who may already have started to use drugs or exhibit behavioursthatmakeproblematicdrugusemorelikely,butwhodonotyetmeetassessmentcriteriaforsubstance dependence. Indicated prevention activities are aimed at preventing or reducing continued use, and preventing problematic and harmful use. Interventions delivered may include: • amentoringprogramme;• groupworkwithknownsubstancemisusers;• individualwork.

For more information on indicated prevention, see Appendix 2.


UsingtheIOMframework(above),agroupofpupilshasbeenidentifiedwithpoorschoolworkandidentifiedneeds (selective) during a whole school approach to personal development and drug education (universal).

Targeted activities with this group have shown some of these young people to be using drugs regularly (indicated).Alocalservicefundedtoprovidegroupworkiscommissionedtoprovideagroupworkexperiencefor these young people.

It must be understood that while it is possible to create three general areas of prevention, treatment and maintenance, the boundaries between prevention and treatment and between treatment and maintenance arenotalwaysclearanddefinitive.Onehasonlytothinkofearlyintervention(counsellingand/orbriefinterventions) where prevention and treatment begin to weave together (see figure below).

Preliminaryresearchsuggestsbriefinterventionsareeffective,particularlyforearlystagedrug/alcoholusers.Usingtheword“brief”doesnotnecessarilymeaneasy.Briefinterventionsareaskilfulwayofworking,usuallycoupled with the use of motivational interviewing. Good assessment is crucial to identify who will benefit mostfrombriefintervention.Trainingandthedevelopmentofskillsareessentialfortheeffectivenessofbriefinterventions.

Universal prevention

Selective prevention

Indicatedprevention

Early intervention

Treatment

Level of medicalisation

Population FOC

US Individual


UniversalAftercare andrehabilitation

Selective

Indicated

Caseidentification Standard

treatment

Compliancewith long–term

treatment

Treatment

Pre

vent

ion

Maintenance

Intervention spectrum for behavioural disorders

TherecommendationsbyNICEforyoungpeoplehavingbeenidentifiedtobeathighriskofdevelopingdrug/alcoholabuseordependenceare included in Appendix 3 to help bridge prevention and treatment needs.

In2009,theEuropeanMonitoringCentreforDrugsandDrugAddiction(EMCDDA)presenteda pictorial view of how the levels of prevention –universal,selectiveandindicated–interfacewith treatment.21

Source:MrazekPJandHaggertyRJ(eds).Reducingrisksformentaldisorders.InstituteofMedicine,WashingtonDC.NationalAcademyPress,1994.

Effective prevention principlesWhat helps prevention work?Below is a list of principles based on Nation et al that should be used to guide effective prevention work.iThisisnotnecessarilyanexhaustivelist;however,ongoingresearchandevidencecontinuetohighlighttheseasimportantelementsofeffectivepreventionwork.Whileeverydrugpreventionprogramme or intervention will not incorporate all of these elements, it is recommended that organisationsorprojectsreviewexistingprogrammesinlightoftheseprinciplesandensurethatallfuture programmes are designed with these principles in mind.

Understandingriskandprotectivefactorsiscentraltounderstandingeffectivedrugandalcoholprevention.Preventioninitiativesshouldattempttoreduceknownriskfactorsand/orenhanceprotective factors for drug and alcohol abuse.

PRINCIPLES RELATED TO PROGRAMME ELEMENTS, CONTENT AND DELIVERY

1. Prevention initiatives should be comprehensive, employing multiple approaches in multiple settings.

Multiple approaches Programmesthatuseknowledge,affective(egself-esteem)andskillselementshavebeenshowntobemoreeffectivethanknowledgeorawarenessonly.

Multiple settingsThere is some evidence to support the idea that combined parent, peer and school interventions support successful positive outcomes (see box below). So, for example, if young people are the target audiencethenprogrammesshouldseektoaddresspeerinfluence,school,familyandcommunityissues.

Programmes,therefore,shouldbewellplannedandawareof:• thetargetpopulation(whotheprogrammeisaimedat,ensuringitmeetslocalneed);• thesetting(whereitisgoingtotakeplace);• theapproach(whatisgoingtobedoneandhow);• howitisgoingtobeevaluated.

2. Prevention initiatives should be active and skills based.

Active learning approaches have been found to be more beneficial than passive learning.

Examplesofspecificskillsincludeimprovedcommunication,assertivenessskills,andskillsforresisting peer pressure.

Velleman et al highlighted the importance of the involvement of parents, especially in relation to younger children and early adolescents.ii Recruitment and sustained involvement is more successful if the issues covered are wider than drugs, there is small group interaction, and there are close links with school and community. When targeting local geographical communities, the evidence would suggest that key community representatives need to be involved in the planning and implementation of the programme.

Pull-out section

3. Prevention initiatives should be of sufficient quantity and quality.

The greater the needs of the participants, the greater the intensity of the prevention initiative. The effectsofinterventionstendtograduallydecayovertime;therefore,effectiveinterventionscouldincludeafollow-uporboostersession(s)tosustaintheimpact.Lackofrobustresearch,however,meansthatthelong-termimpactofsuchworkisunknown.

4. Prevention initiatives should be theory driven.

Preventioninitiativesshouldtakeintoaccountwhathasbeenproventowork.Therearemanyprogrammesand/orapproachesthathavebeenshowntomakeadifference,andtheseshouldinfluenceyourwork.

Thereisnopointindoingsomething“forthesakeofit”,noristhereanypointin“reinventingthewheel”.However,whenusinginterventionsthathavebeenevaluatedelsewhere,anysocialorculturaldifferencesshouldbetakenintoaccount.

5. Prevention initiatives should encourage the development of positive relationships.

Where children and young people are enabled to develop strong positive relationships especially with peers,parents,teachersand/orsignificantadults,thisisassociatedwithpositiveoutcomes.

6. Prevention initiatives should encourage people to look at both the long and short- term consequences associated with drug and alcohol misuse.

Focusing on the longer-term negative effects of substance use only may not impact on younger users. Manypeople,especiallyyoungpeople,areinfluencedmorebythe“hereandnow”,ratherthanbylong-termconsequences.Apositiveattitudetowardusehasconsistentlybeenshowntobeariskfactorforproblematic alcohol and drug use.

7. Prevention initiatives should consider the value of normative education.

Correctionofmisconceptionsabouttheperceivedhighprevalence,availabilityandacceptabilityofdrugusecanbebeneficial.Thisisespeciallytrueiftheyoungperson’skeyfriendsarenotactivedrugusers.

Ifyoungpeoplebelievethatthemajorityoftheirpeeragegroupisdoingsomething,theywillbemorelikelytocopythatbehaviour.Surveysshowthatdruguse,moresothanalcoholuse,remainsrelativelylow among young people in Northern Ireland, and this should be reinforced in prevention settings.

8. Prevention initiatives should avoid poorly constructed and delivered “one-off talks” or group information sessions.

Moreintensiveprogrammeshavebeenshowntobemoreeffective,althoughthefactthattherearemanysessionsalonedoesnotguaranteeeffectiveness.Ultimately,itmaybebettertohaveonehourof good evidence-based material and delivery rather than several mediocre sessions involving poor material.

PRINCIPLES RELATED TO MATCHING THE PROGRAMME WITH THE POPULATION OR PARTICIPANTS: TARGETING THE RIGHT PEOPLE

9. Prevention initiatives should take account of age, maturity, experience and ability of participants as well as considering drug prevalence, availability, legality etc. Effective practitioners will additionally be aware of the fact that young people have different learning styles and will plan appropriately.

TheIoMwarnedthat“ifthepreventiveinterventionoccurstooearly,itspositiveeffectsmaybewashedoutbeforeonset;ifitoccurstoolate,thedisordermayhavealreadyhaditsonset”.iii It is suggested that individual programmes ought to try to have resources, language and approaches which are tailored to the specific subset of the population to whom it is being delivered. This can mean interviewing early in terms of age, early in their substance-use careers, or at points transition such as the more from primary schooltopostprimary.Projectsmustbeclearonwhomtheyaretargeting,andseektoaddressriskandbuild on protective factors.

10. Prevention initiatives should be socio-culturally relevant, taking account of cultural beliefs and practices as well as religious diversity.

They should also consider local community norms. This relevance should go beyond the surface structureoftheprogramme(eglanguage)tolookattherelevanceofthedeeperprogrammestructures.Whenprogrammesarenotrelevant,theymayhavedifficultyinretainingthemoreat-riskparticipants.This is particularly important as Northern Ireland becomes more culturally diverse. Service user involvement with the planning and delivery of programmes can help to address this.

PRINCIPLES RELATED TO IMPLEMENTATION AND EVALUATION OF PROGRAMMES

11. Programmes should evaluate both delivery and impact.

Evaluating delivery measures whether participants felt that the programme was clear, effectively delivered and had good resources. A short questionnaire may be used. Evaluating impact measures whethertheprogrammemakeadifferencetoparticipants’knowledge,attitudesorbehaviour.Thisinvolves gathering the same information before and after the programme to measure if it made a difference.

Evaluationshouldbeongoingsothatchangescanbemadetointerventionsastheydevelop.Changesneedtotakeaccountoftheviewsofparticipants,andconsideriftheinterventionisreallymakingadifference.

12. Staff delivering the programme should be well-trained.

The implementation of prevention programmes is enhanced when staff members are sensitive, competent and have received sufficient training, support and supervision. Even where effective training hastakenplace,theeffectivenessofstaffcanbeunderminedorlimitedbyhighratesofstaffturnover,lowmoraleoralackof“buy-in”.Staffdeliveringinterventionsshouldbeawareofotherlocallyaccessibleinterventionsand/ormaterials,shouldtheyneedtoreferpeopleon.

Anyone planning a prevention initiative or planning to deliver an existing initiative should be aware of these issues and should aim, in so far as is possible, to include their use in that prevention initiative.

Referencesi.NationM,CrustoC,WandersmanA,KumpferKL,SeyboltD,Morrisey-KaneE,DavinoK.Whatworksin prevention:principlesofeffectivepreventionprograms.AmericanPsychologist2003;58:449-456.

ii. VellemanR,MistralW,SanderlingL.Takingthemessagehome:involvingparentsindrugprevention. London:HomeOffice,2000.

iii.InstituteofMedicine.Reducingrisksformentaldisorders:frontiersforpreventiveinterventionresearch (editedbyMrazekPJandHaggertyRJ).WashingtonDC:NationalAcademyPress,1994.

Planningandinitiatingapreventionprogramme In practice, the three important elements of a drug prevention intervention are the target population, the setting and the approach.

The diagram below illustrates the prcesses by which a prevention initiative may come into existence.

1. The populationAsdiscussedearlier,theIOMframeworkforclassifyingpreventiondividedthecontinuumofcareintothreeparts:1)Prevention;2)Treatment;3)Maintenance.Thepreventioncategorywasfurthersubdividedintothreeclassifications:a)Universal;b)Selective;c)Indicated.18

Universalreferstothegeneralpopulation(egawholeschoolproject).Selectivereferstoasubgroupofthewholepopulation(egalltheboysandgirlsidentifiedasbeingatriskintheschool).Indicatedreferstospecificindividuals who have exhibited specific problems (eg boys in a given school who have been caught with drugs).

So… how is the group going to be targeted? Is this a universal programme for everyone? Is it for a group living in a certain postcode or community with indicated needs? Is it a selective group with a specific drug problem or is it an individual with selective needs?


Personal and social

development

Valuesand

beliefs

Acceptance andunderstandingof others

Participation

Consult withgroup to determine

their needs.Needs assessment, audit and research

Monitor andevaluate, then

modify theprogrammeaccordingly

Implement theprogramme

Secure theresources to

implement theprogramme effectively

Agree and plan a programme

with the group

Consider personalcircumstances and

environmentalfactors. Create

aims and objectives

2. The settingBroadlyspeaking,thisisdividedintosixcategories(whichcanbefurthersub-dividedasnecessary).Thesixmain settings are:

i. The individual–whatistheindividuallikeintermsofage,gender,maturity,experience,literacy, academic ability, participation, trust level, expectations or other relevant factors?ii. The family–howdoesthefamilyfunctionintermsofbonding,connection,involvement, communication,negotiation,problemsolving,historyofdruguseormisuse/abuse/dependency, parentingskills?iii. The school or workplace–whatarethelevelsofconnection,academicfailure,rewardor recognition,typesofleadership/teaching,theschool/workclimateandculture,levelsofsupportat which power is shared?iv. Peers–whataretheconnectionswithinthegroup,howgreataninfluenceisthegroup(orparticular individuals/leaders)oneachother,howmuchnegotiationordebateispossiblewithinthegroup,etc?v. The community–whatarethecommunitynormswhenitcomestodrugsandalcohol,locallawsand bye-laws versus local practices, levels of community involvement and empowerment, existence of paramilitaries,levelsofdeprivationand/orlackoffacilities?vi. The wider environment–whataretheissuesthathappenatthemacroorgovernmentlevelsuchas taxes on alcohol and tobacco, laws around controlled drugs, police enforcement policies, age limits, public policies, prescribing practice, or dealing with drug dealers in a locality?

Considerationmaybegiventohowacombinationofvarioussettingscanbeutilised.

3. The approach Throughoutthepastfewdecades,anumberofdifferentapproachesunderpinningpreventionworkhavebeendeveloped. These include:

i. Health information–whileonitsownitwillhavelimitedimpact,healthinformationcanincrease awareness and, with hard-hitting messages, create an emotional arousal.ii. Personal development approach–specificresistanceandcopingskillsaretaught.Programmes suchastheseattemptstoempowertheindividualbyhelpingthemdevelopsocialskillsandenhancing their self-esteem. Other names for this approach include assertiveness training, affective education, resistanceandrefusalskills,decision-makingskills,buildingself-esteem.iii. Providing alternatives to drug use–thisinvolvesorganisingalternativeactivitiesasameansof reducingthelikelihoodofdruguse,forexampleinvolvingyoungpeopleinoutdoorpursuitsandshowing them how they can achieve a “natural high”. It can include active involvement in sports, hobbies and community service.iv. Harm reduction–thisapproachtakesapragmaticviewthatnotalldruguserswanttostoptheirdrug taking,sominimisingthehealth-relatedharmisabenefittotheindividual,totheirfamiliesandto society. A “harm-minimisation” approach creates a hierarchy of health goals which includes abstinence, but also a range of short-term and, arguably, more achievable goals.v. Peer education–thisrestsontheviewthatyoungpeoplelearnalotfromoneanotheraspartoftheir everydaylivesandchoices.Peergroupsplayanimportantpartindefininganindividual’sidentity. Within this approach, peer educators (ie someone of equal status) are thought to have credibility andthusserveasrolemodels.Cautionisneededinrespectofpeereducationasitisoftenthepeer educators who benefit most. It remains unclear whether the training the peers receive has a beneficial impactonthem.Someevidencesuggeststhatgroupinglowriskandhighriskpeerstogethercan bedetrimentaltothelowriskgroup(seeSanchezetalandArgysandReesoncontagioneffectswithin mixed peer groups 24,25).vi. Community development–thisisaboutdevelopingthepower,skills,knowledgeandexperience ofpeopleatalocallevel,enablingthemtoundertakeinitiativeswithintheircommunitytocombatsocial, economic, political and environmental problems. It is a bottom-up rather than a top-down approach.vii. Legislative approach–thisreliesondevelopinglegislationthatlimits,moderatesorpreventsdrug use in society. Its effectiveness depends on the clarity and enforceability of the specific laws. Examples includeagelimitsonpurchasingalcoholortobacco,smokingbansinpublicplaces,drinkordrug- driving charges.


viii. Family approach–whilethefamilycanbethesettingforprevention,focusingonfamilydynamicsand building protective processes within the family is also an approach. This can be accomplished individually, with whole families, or parents in a group setting. The approach examines issues within the family such as bonding, communication, clear rules regarding substance use and supervision that influencethelevelordegreeofmisusebymembersofthefamily.ix. Mentoring–“mentoringistosupportandencouragepeopletomanagetheirownlearninginorder thattheymaymaximisetheirpotential,developtheirskills,improvetheirperformanceandbecomethe persontheywanttobe”(OxfordSchoolofCoachingandMentoring,www.theocm.co.uk).Mentors actasrolemodelswhocanencouragepeopletomakepositivechangesintheirlives,suchasregular schoolattendance,takingpartinfurtherorhighereducation,andstayingoutoftroublewiththelaw.x. Media campaigns–thesecampaignsreachlargeaudiencesandareeffectiveinthelongtermat influencingculturalchange.Theseinfluencescanbemoreeffectiveifsupportedbyotheractions.xi. Supply reduction–restrictingtheaccessto,andtheavailabilityof,drugs.

Puttingthethreebuildingblocks–population,setting,approach–togetherallowsfortheplanningandexecution of an effective drug prevention initiative.

There is no specific order in which the three elements have to be decided on. It may be that a population (eggroupofyoungpeople)presentsitselfashighrisk,oryoudiscoveragoodprogrammewhichhasworkedwellelsewhereandyouwishtoreplicateit/pilotitlocally(approach),oramappingexercisefindsaparticularsetting (eg schools) to be under-served in terms of provision.

Below are some examples of how an initiative may come about. These are only two examples as there are many creative ways that can be effective in prevention efforts.

Example 1–Wearegoingtorunaprogrammeforteenagedrinkers(population)withagroupnolargerthan12,whohavebeenidentifiedasregularbingedrinkersinacertaincommunity.Itwillinvolveasixsessionprogrammeinalocalyouthcentre(setting)culminatinginanoutward-boundweekendawayintheMournes.Alife-skillsapproachwillbetaken,alsoincorpoatingalternativeordiversionaryactivities,andtheprogrammewillbe delivered by trained peer educators.

Inadvanceoftheprogramme,theyoungpeopleareconsultedandsomethoughtgiventotheriskfactors:livinginacertainneighbourhood,mixingwithacertainpeergroup,havingapositiveviewofand/orpositiveexpectancies of alcohol use.

Example 2–Parents(population)inalocalcommunityhaveidentifiedpreventingalcoholanddruguseasanimportant issue for them. A programme is being organised using the school as a source of recruitment. The programmewillbeopentoparentsfromtheentireschoolcommunity(setting).Theprogrammeseekstobuildtheparents’confidencetotalkopenlyaboutdrugsandalcoholtotheirchildren.Itwillhelpbuildtheparents’understandingofriskandprotectivefactorsandfocusonkeyprotectiveprocessesincludingsettingclearrules, clarifying expectations, monitoring behaviour, communicating regularly, examining their own attitudes and modelling positive behaviours (family approach).


Conclusion

Aspage30oftheNSDADstatesunder6:14WorkforceDevelopment:

“Abroadrangeofworkershaveakeyroletoplayinaddressingsubstancemisuse,andreducingsubstancemisuse should be regarded as a core business to many services. It is clear that the successful implementation oftheNSDwillrequirecolleaguesinrelatedsectorstorecognisethesignificantcontributiontheycanmaketoaddressingdrugandalcoholissues.Althoughnumbersintheworkforceareimportant,itisthecompetenceofthose staff which has the most crucial relationship to achievement of the NSD aims.”2

Itisessentialthatallthoseworkinginpreventionembracetheprinciplescontainedinthisdocument.Furthermore,itishopedthattheseprincipleswillinfluenceandcontributetothetrainingofthosewhoworkinthe field of substance misuse prevention.

To reiterate: prevention is better than cure. It is hoped that the efforts put into prevention have the desired impact–tobeeffective.

Wheredolocalpreventionefforts,interventionsandresearchgofromhere?Currentworkisexaminingthebuildingblockstoresilience,theroleofexpectationsinyoungpeoples’drinking,whataninterventionwithparentsachieves,andtrainingstaffinbriefinterventionandmotivationalinterviewingskillsamongotherareasofdevelopment.

It will be through evaluation of current efforts and examination of emerging research that we will have a better understanding of what is effective in prevention of alcohol and drug misuse in Northern Ireland.

KeymessagePrevention is a broad area, and prevention work of one kind or another is necessary at every stage of a person’s relationship with drugs and/or alcohol. In order to be able to best address the area of prevention, the use of the principles contained in this document is recommended.

They are to be understood as pointers to aid more effective and purposeful prevention working rather than an exhaustive list of compulsory elements.

It would be hoped that existing services would attempt to incorporate them into existing practice and that new services or work would be planned with them in mind.


TITLE

SUMMARY

AIMS & PURPOSE

TARGET POPULATION

PRACTITIONERS

KEY TASKS

INTERVENTIONS

TIER 1

Universal and generic.

Frontline of service delivery

with direct access for young

people and their families

To ensure universal access to

all generic services for

young people and to identify

those vulnerable to substance

misuse issues

All young people

Include teachers, voluntary

agencies, social services, police,

school medical sta�, GPs,

nurses in primary care,

potentially young people as

con�dantes and peer educators

Assessment of all young people

for tobacco, alcohol, drug use

and misuse & identi�cation of

those that are more vulnerable

or at risk. Appropriate referral

as necessary

Information and advice, health

promotion, drug prevention

programmes, support for young

people and their families

TIER 2

Frontline of specialist services.

Youth oriented services

delivered by practitioners with

specialist youth knowledge

and some knowledge of drugs

and alcohol

To reduce risks and

vulnerabilities, reintegrate

and maintain young people

in mainstream services

All young people, but in

particular those with more

problematic drug use or

additional vulnerabilities

Include CAMHS, voluntary

youth services, paediatric &

psychology sta�, Connexions

personal advisors,YOT drugs

workers, and others with a

specialist remit within universal

services. Practitioners with

addiction skills must be

incorporated into services and

not work in isolation

Holistic assessment of the

young person, to clarify degree

of substance use problem

in the context of other

vulnerabilities. Clear referral

pathways and links with

tier 1 & 3 services. Case worker

role, including maintaining

contact with the young person

during involvement with tier

3/4 services

Proactive outreach [including

use of non-professional sta�,

young people and communities

to conduct outreach work],

information and advice,

practical advice on associated

issues [eg housing], crisis

support, delivery of targeted

prevention programmes,

appropriate therapies [e.g. family

therapy], generic counselling

TIER 3

Services provided by

specialist teams

To respond to the complex

and often multiple needs of

the young person, not just in

relation to substance use

problems. To reintegrate the

young person into their

family, community, school,

training or work

Young people with tobacco,

alcohol and drug problems that

signi�cantly interfere with

other aspects of the individual's

life. Multiple underlying

problems often also exist

Multi disciplinary teams

tailored to meet the speci�c

needs of the young person and

capable of responding to

problems of high complexity.

Teams could include mental

health, paediatric and addiction

specialists working in close

collaboration with education,

social services and YOTs

Comprehensive assessment

and formulation of an overall

care plan. Delivery of a

spectrum of interventions.

All substance interventions set

within the context of integrated

and comprehensive packages

of care

Provision of multi-component,

multi-faceted and multi-agency

interventions for complex

problems facing young people

and their families.

Pharmacotherapy provision

and ongoing monitoring,

harm minimisation and

uncomplicated detoxi�cation

TIER 4

Very specialised services

To provide specialist

intervention[s] and setting for a

particular period of time and

for a speci�c function, as an

adjunct to and backstop for the

services provided in other tiers

Young people with complicated

substance problems requiring

speci�c interventions and/or

care and protection

Include child/adolescent

addiction and forensic

psychiatry, social services,

paediatrics and voluntary sector

Particular interventions or

focused work over short or

temporary periods. Continuity

of care to be maintained

through the continued

involvement of tiers 2 and 3

before, during and after

admission. Responding to child

protection and other dangerous

situations. Adding further

depth of understanding to

comprehensive assessments

carried out at tiers 2 & 3

Inpatient adolescent units or

forensic units supported by

specialist young people's

addiction teams, adolescent

paediatric beds, intensive day

centres, crisis management,

specialised housing or

fostering, multi component or

highly intensive therapies that

have a residential component,

complicated detoxi�cation and

pharmacological interventions

Tiers summary - Adapted by National Collaborating Centre for Drug Prevention from Health Advisory Service 2001

Appendix 1

Four tier model of services26


Appendix 2

Indicated prevention

AccordingtoEMCDDA,indicatedpreventionstrategiesaredesignedtopreventtheonsetofsubstanceabusein individuals who are showing earlier danger signs, such as falling grades and consumption of alcohol and other gateway drugs.

Theeffortisaimedatindividuals,with“substance-abuse-likebehaviouratasubclinicallevel”,withthegoaltoidentify these individuals and target them with special programmes.

Developmental psychopathology and child psychiatric research are also relevant to prevention strategies becauseindividualswithahighriskoffailingtomeetdevelopmentaltasks(suchasschool,peercontacts)areoftenpredisposedtoanelevatedriskofdevelopingsubstanceabuseandmanyhavechildpsychiatricdisordersshow a strong correlation with the development of a dependence.

Asindicated,preventioncanbeseentoliesomewherebetweentreatmentandselectiveprevention;itisnecessarytoidentifythepointsatwhichthesedefinitionsoverlap.Cleardefinitionsofthetargetgroupsforthedifferentinterventions,basedontheirlevelofrisk,willalsobeanimportantfactorindeterminingefficacy.

Indicated prevention describes a preventive, individualised approach targeted at those at risk of developing substance abuse or dependence later in life. That there is a need for indicated prevention is shown by existence of strong indicators for the development of a later substance use disorder.


Universal prevention

Selective prevention

Indicatedprevention

Early intervention

Treatment

Level of medicalisation

Population FOC

US Individual

However,thebordersbetweenthedifferentinterventionstrategiesarenotclear-cut(seeabove).Indefiningindicated prevention, the overlap between it and treatment is of special interest, as here the worlds of prevention and treatment collide. This can create problems in a line of dwindling financial resources, as each sidemayarguethattheothersidemighttakecareofthispopulation.

Thetaskofdifferentiatingbetweentreatmentandindicatedpreventionismademoredifficultbythefactthattreatment itself is seldom clearly defined. In Guidance for the measurement of drug treatment demand, “drug treatmentisconsideredtobestructuredinterventionaimedspecificallyataddressingaperson’sdruguse”.27

However,thedefinitionremainsvagueinitspracticalapplicability.Forexample,insurancecompanieswillpayforthetreatmentofclassifiedanddefineddisorders(ICD-10orDSM-IV*),butnotforthetreatmentofconditions. It should be stressed, though, that whenever a defined disorder (here, a substance use disorder) is present, treatment is necessary.

Within the group that can be identified as requiring prevention, there is a section for which “early intervention” is appropriate. This sub-group includes people who show strong indicators of developing substance abuse laterinlifeandwhoconsumedrugs,butnottoanextentthatpermitsICD-10orDSM-IVdiagnosisofsubstanceabusedisorderordependence.Comparedtootherpreventionapproaches,earlyinterventioniscloser to treatment and, therefore, often requires services from the medical system.

Indicated prevention can be summarised as:• Preventativeinterventionsthataretargetedattheindividual.• Theindividualpresentsvoluntarilyorisreferredtoanexpertby,forexample,parents,teachers,social workers,paediatricians.• Theindividualisidentifiedonanindividuallevelbasedonaprofessional’sevaluation.• Theindividualmightexhibitsubstanceuse,butdoesnotfulfilcriteriafordependence(accordingto ICD-10orDSM-IV)and/orshowsindicatorsthatarehighlycorrelatedwithanindividualriskof developing substance abuse later in life (such as psychiatric disorder, school failure, antisocial behaviour). Substance use is not a necessary condition for inclusion in preventive interventions.• Distinguishedfromselectivepreventionbythestrongercorrelationandindividualisednatureof indicators for the development of a substance abuse or dependence.• DistinguishedfromtreatmentbytherequirementofindividualstofulfilICD-10orDSM-IVcriteriafor substance abuse to receive treatment.• Theaimofindicatedpreventionisnotnecessarilytopreventtheinitiationofuseortheuseof substances, but to prevent the development of dependence, to diminish the frequency and to prevent ‘dangerous’substanceuse(egmoderateinsteadofbinge-drinking).Inaddition,someindicated prevention measures are classified as early interventions, which can be defined as interventions targeted at individuals with identified strong indicators and substance use (but who do not warrant ICD-10orDSM-IVdiagnosis).• Thefieldof“earlyintervention”iswithintheoverlappingbordersofindicatedpreventionandtreatment.

*International classification of diseases (ICD)bytheWorldHealthOrganizationandtheDiagnostic and statistical manual of mental disorders (DSM-IV)bytheAmericanPsychiatricAssociationareusedforthediagnosisofavarietyofconditionsanddisorders,includingdrugandalcoholabuse/dependenceandco-morbidconditionsincludingdepression,anxietyorschizophrenia.28,29

Early intervention describes the approach situated between the overlapping fields of indicated prevention and treatment. The target group is individuals who already use drugs, but who do not fulfil ICD-10 or DSM-IV criteria for substance abuse or dependence.

Early intervention can be classified as prevention, though treatment is often required at this stage of substance use.


Appendix 3

NICE guidance

Intheeventofyoungpeoplehavingbeenidentifiedasathighriskofdevelopingdrug/alcoholabuseordependence,NICEguidelinesrecommendthefollowingactions:6

Target population• Vulnerableanddisadvantagedchildrenandyoungpeopleaged11–16yearsandassessedtobeathigh riskofsubstancemisuse.• Parentsorcarersofthesechildrenandyoungpeople.

Who should take action?PractitionersworkingwiththesepeopleintheNHS,localauthoritiesandtheeducation,voluntary,community,socialcare,youthandcriminaljusticesectors.Inschoolsthisincludesteachers,supportstaff,schoolnursesand governors.

What action should they take?• Offerafamily-basedprogrammeofstructuredsupportovertwoormoreyears,drawnupwiththe parents/carersandledbycompetentstaff.Theprogrammeshould:➢ - includeatleastthreebriefmotivationalinterviewseachyearaimedattheparentsorcarers;➢ - assessfamilyinteraction;➢ - offerparentaltrainingskills;➢ - encourageparentstomonitortheirchildren’sbehaviourandacademicperformance;➢ - includefeedback;➢ - continue even if the child or young person moves schools. • Offermoreintensivesupport(egfamilytherapy)tofamilieswhoneedit.

Target population• Childrenaged10–12whoarepersistentlyaggressiveordisruptiveandassessedtobeathighriskof substance misuse.• Parentsorcarersofthesechildren.

Who should take action?Practitionerstrainedingroup-basedbehaviouraltherapy.

What action should they take?• Offergroup-basedbehaviouraltherapyoveronetotwoyears,beforeandduringthetransitionto post-primaryschool.Sessionsshouldtakeplaceonceortwiceamonthandlastaboutanhour.Each session should:➢ - focusoncopingmechanismssuchasdistractionandrelaxationtechniques;➢ - helpdevelopthechild’sorganisational,studyandproblem-solvingskills;➢ - involve goal setting.• Offertheparentsorcarersgroup-basedtraininginparentalskills.Thisshouldtakeplaceonamonthly basis, over the same period (as described above for the children). The sessions should:➢ - focusonstressmanagement,communicationskillsandhowtodevelopthechild’ssocial- cognitiveandproblem-solvingskills;➢ - advise on how to set targets for behaviour and establish age-related rules and expectations for their children.

Target populationVulnerableanddisadvantagedchildrenandyoungpeopleagedunder25yearswhoareproblematicsubstancemisusers (including those attending post-primary schools or further education colleges).

Who should take action?Practitionerstrainedinmotivationalinterviewing.

20Guidingeffectivedrugprevention

What action should they take?• Offeroneormoremotivationalinterviews,accordingtotheyoungperson’sneeds.Eachsessionshould last about an hour and the interviewer should encourage them to:➢ - discusstheiruseofbothlegalandillegalsubstances;➢ - reflectonanyphysical,psychological,social,educationandlegalissuesrelatedtotheir substancemisuse;➢ - set goals to reduce or stop misusing substances.


For NICE guidance concerning prevention in vulnerable young people, see http://guidance.nice.org.uk/PH4

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ContactsEastern Drugs and Alcohol Coordination Team (EDACT)PublicHealthAgency,OrmeauAvenueUnit,18OrmeauAvenue,BelfastBT28HSTelephone:02890279398Fax:02890311711

Northern Drugs and Alcohol Coordination Team (NDACT)PublicHealthAgency,NorthernOffice,CountyHall,182GalgormRoad,BallymenaBT421QBTelephone:02825311111Fax:02825311122

Southern Drugs and Alcohol Coordination Team (SDACT)PublicHealthAgency,SouthernOffice,TowerHill,ArmaghBT619DRTelephone:02837414557Fax:02837414634

Western Drugs and Alcohol Coordination Team (WDACT)PublicHealthAgency,2ndFloor,AndersonHouse,MarketStreet,OmaghBT781EETelephone:02882253950Fax:02882253959

04/10ProducedbythePublicHealthAgency,OrmeauAvenueUnit,18OrmeauAvenue,BelfastBT28HS.Tel:02890311611.

Textphone/TextRelay:1800102890311611.www.publichealth.hscni.net

guiding effective drug prevention - ascert · • those wishing to set up a prevention project –...

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